t is good to see the debate on the merits or de-merits of Levodopa opening
up. It is fortunate (and I don't mean this in any derogatory way ) that we
have at least 2 MDs on the list. (and doubly fortunate that they happen to
take opposite sides in the debate. This enhances the impact of the arguments
in a way that numerous e-mails from little old me have failed to achieve in
the past 12 months or so.
Of course I agree 100% with Jorge A Romero's arguments, and so naturally I
disagree strongly with Hans van der Genugten. I also believe that I can
define a viewpoint on the whole affair which could find acceptance with
both parties.
The first thing that I bring to the discussion is that I have arrived at my
conclusions NOT by reviewing the reports from both sides and awarding
points for technical merit (I am not trained to do that). What I am trained
to do is think logically, to form hypotheses, to test the hypotheses
against the available data and after numerous attempts perhaps arrive at an
undestanding which allows us speculate a bit further forward in some new
direction.
) It seems to me that both groups are missing a vital point in the way that
they use the data, and especially the hated Dyskinesias. They seem to
regard Dyskinesias as rather like icebergs floating around in an ocean,
just waiting to sink us as we try to navigate through the day, but on a
random basis. This is nonsense.
A far more meaningful relationship can be defined, which I used in my
analysis program about 6 years ago. This requires the patient to define
his 'Condition' as a continuous function through the day. This condition
is expressed as an arbitrary number, ranging from -2 to +2 , and is
calibrated (at the crudest level) as follows:
-2 - Fully 'off', resting tremor, falling, freezing etc (Chose the
most appropriate as it refers to your condition
-1 - Similar symptoms as -2 but at a level that you could live with.
0 - The target! Zero is how you used to feel before you were
diagnosed. Remember that ?
+1 - Mildly overdosed e.g. light dyskinesia, possibly cramps,
difficulty walking, etc
+2 - Unacceptable dyskinesias, rigid legs ..
The point of that table is not to define a series of steps, but to define
points on a continuously varying scale. I found that with practice, I
could define my condition as ,say -0.6 , or +1.2 (And to give a good
analysis it is desirable to resort to 1 decimal place accuracy ).
Now, if you can accept the concept of the condition scale (I do, because
I've done it) you are now talking computer language. The next question
is: What do you plot it against? Answer: The levodopa flow rate expressed
as milligrams of levodopa per hour.
If you are still with me you will see that I have defined or assumed a
relationship between the tablets e.g. as we take them by mouth, and
condition, which is how that tablet affected me. What goes on between
those two points? Well, that is why I wrote a program (And it works)
The point of the above (and I apologise for the length of it) is to
introduce you to the concept that there is a specific rate of intake of
levodopa which, if you can hit it with accuracy and maintain it with
accuracy will result in you feeling just like BP (before Parkinsons).
DYSKINESIAS:
ARE NATURE'S WAY OF TELLING YOU THAT YOU HAVE TAKEN TOO MUCH LEVODOPA
I am writing too much (sorry) I will try to summarise the rest of my
argument in a sequence of Banner headlines:
MOTOR FLUCTUATIONS:
OCCUR BECAUSE THE 'WINDOW' AT WHICH YOU ARE AIMING YOUR LEVODOPA DOSE
GETS SMALLER BECAUSE YOU CONTINUE TO LOSE DOPAMINERGIC CELLS. IF YOU
CONTINUE TO THROW LARGE ROCKS INSTEAD OF SMALL PEBBLES OF LEVODOPA YOU
WILL GET UNPREDICTABLE MOTOR FLUCTUATIONS.
And finally, to demolish the fuzziest piece of logic I have seen in many
a year, which says: If you delay the introduction of levodopa for several
years, you MAY find that the levodopa retains its effectiveness longer
in the later stages. (Note the use of MAY find:. They are already padding
their backsides in case they are wrong)
Here we go for the last time:
THE CONVERGENCE OF THE DYSKINESIA LINE AND THE DEMAND LINE IS A FACT, AND
THERE COMES A TIME WHEN YOU CANNOT TAKE ANY MORE LEVODOPA. HOWEVER, THIS
ALSO IS DUE TO THE ON-GOING LOSS OF DOPAMINERGIC CELLS AND HAS NOTHING TO
DO WITH HOW MUCH LEVODOPA YOU TAKE
--
Brian Collins <[log in to unmask]> (59/39/34)
